Category: Health

Scare stories and newspaper nonsense

  • Overconfidence and incompetence

    Something we’re seeing a lot of during the coronavirus crisis is the rise of the armchair epidemiologist: the men (it’s mainly men) presenting themselves as authoritative voices about things they have no expertise in.

    Sarah Weinman, for InsideHook.com:

    They are lawyers, former reporters and thriller writers, Silicon Valley technologists, newspaper columnists, economists and doctors who specialize in different parts of medicine. Their utter belief in their own cognitive abilities gives them the false sense that their speculation, and predictive powers, are more informed than the rest of ours.

    They’ve been with us for a long time, of course – the blogging world is full of them – but coronavirus has given some of them a much bigger audience, and that has made some of them dangerous. The UK press and social media is full of grifters speaking with great certainty about things they know nothing about, and those things currently include how to deal with a lethal global pandemic.

    There is a name for this, and it is the Dunning-Kreuger effect. The effect is often explained as “stupid people are too stupid to know they are stupid”, but it’s more nuanced than that. It’s not that people are stupid. Many of the people who clearly have DK are very clever. It’s that they are blinkered: they lack the knowledge to understand what knowledge they are lacking.

    For example, let’s say you’re an economist. If you turn your attention to the likely outcome of the coronavirus, you may come up with different answers than the virologists and epidemiologists do. That doesn’t necessarily mean the virologists and epidemiologists are wrong; it’s much more likely that you’re making ignorant assumptions and rookie mistakes that people in the field don’t make. You don’t know that you’re making them, because this isn’t your area of expertise.

    Where the Dunning-Kreuger effect comes into play is when you decide that if the experts disagree with you, it means it is the experts who are wrong.

    Who better to speak to about the Dunning-Krueger effect than David Dunning, one of the two professors who coined the term? That’s who Sarah Weinman interviewed.

    The problem is that some people can take things they know and misapply it to this new situation. A lot of people think, “Oh, this is a flu,” so they use what is common knowledge of the flu to guide them. But this virus is not the flu. Knowledge is a good thing, but they don’t realize it’s a misapplication.

    I used the example of an economist because that’s a field Dunning specifically mentioned.

    Confidence comes from knowing something, but not realizing you don’t know everything you need to know. If you’ve been rewarded as a successful economist, you deal with formal models in math, and you have confidence in what you do. This can be true of all of us in our area of expertise.

    That confidence may be perfectly justified in economics, but that doesn’t necessarily mean that you have anything valuable to say in other fields.

    Elon Musk is a great example of this. The Tesla boss has an electric car company and launches rockets into space. And when a bunch of kids got stuck in a cave in Thailand, Musk rode to the rescue with a special high-tech submarine to save them.

    The submarine was useless, because it wasn’t able to navigate the caves. When criticised, Musk called an expert diver – the diver who actually helped rescue the trapped kids – a “pedo”.

    Musk has since moved into providing ventilators for coronavirus patients. The machines he supplied are not ventilators. It’s surely just a matter of time before he calls the doctors “pedos” too.

    Here’s one example of why these overconfident men are dangerous: Richard Epstein. Epstein has arguably contributed to the US death toll: his prediction that the coronavirus would only kill 500 Americans was widely shared in US conservative circles and helped inform US government policy on how to respond to the potential loss of life.

    As NY Mag reports:

    A week later, Epstein conceded that he had committed a math error, and the real number would be 5,000 deaths, though “it, too, could prove somewhat optimistic.”

    At the time of writing, the US toll is about to pass 50,000 deaths.

    …Somehow this experience has not shaken Epstein’s confidence in his own ability to outthink the entire field of epidemiology.

    There’s an astonishing interview with Epstein in The New Yorker where he throws a tantrum.

    O.K. I’m going to tell you. I think the fact that I am not a great scholar on this and I’m able to find these flaws or these holes in what you wrote is a sign that maybe you should’ve thought harder before writing it.

    What it shows is that you are a complete intellectual amateur. Period.

    O.K. Can I ask you one more question?

    You just don’t know anything about anything. You’re a journalist. Would you like to compare your résumé to mine?

    Part of the reason grifters have achieved such prominence is because the people in authority often have the Dunning-Krueger effect too.

    The UK government is a stellar example, but you can also see it in things such as authorities urging us not to wear masks because they don’t really prevent you from getting the virus (even though proper ones do, which is why health workers use them, and though they do have a proven effect of reducing the danger of you spreading the virus to others if you don’t realise you have it). When official sources are often wrong, it creates a vacuum that grifters are all too ready to fill with bullshit.

    In the MetaFilter discussion of the article, one commenter posted:

    Science and these various “experts in stuff” both operate in uncertain environments, but treat uncertainty in totally opposite ways.

    …Experts in stuff… use uncertainty as a means to an end, so they generally try to increase it. Since science shows its cards with regards to uncertainty, they can always argue a reasonable level of skepticism of science. Then they can turn around and present some alternative facts and arguments about their own position on the matter. The idea isn’t about the next researcher, or a process to eliminate uncertainty, it’s simply to be convincing. They don’t care if they are right – only if they are perceived as right.

    This is why these “experts” can be so troubling to deal with. They’ll stake a claim against anything, as long as it gets them to their goal. Sometimes it’s just to be respected, but sometimes it can be much darker.

  • Don’t be an optimist

    If you’re worried about losing your mind during lockdown, here’s some advice from an expert: don’t be an optimist.

    Admiral Jim Stockdale was held in the “Hanoi Hilton” prison camp for seven years, where he was tortured more than twenty times. He says he came out of the camp stronger than when he went in. Speaking to Jim Collins, he explained:

    I never ever wavered in my absolute faith that not only would I prevail—get out of this—but I would also prevail by turning it into the defining event of my life that would make me a stronger and better person.

    When Collins asked him about the people who didn’t survive so well, Stockdale answered:

    I can tell you who didn’t make it out. It was the optimists… They were the ones who always said, ‘We’re going to be out by Christmas.’ Christmas would come and it would go. And there would be another Christmas. And they died of a broken heart.”

    Of course, being in lockdown in a nice house or flat is hardly the same as being a prisoner of war. But Stockdale’s argument is a sound one. To take a slightly less impressive character, John Cleese’s headmaster in the 1986 film Clockwise:

    It’s not the despair, Laura. I can take the despair. It’s the hope I can’t stand.

    Or perhaps you prefer Stephen King? Here’s a bit from his novel Joyland:

    You think Okay, I get it, I’m prepared for the worst, but you hold out that small hope, see, and that’s what fucks you up. That’s what kills you.

    I’m not suggesting we should all go around in abject misery, weeping and wailing and gnashing our teeth. But I do think that focusing on anything that is not within our control is going to be bad for our mental health. For example, if you were hoping that the lockdown would be lifted last week, how did you feel when it was extended? How will you feel if it’s extended again?

    Stockdale:

    This is what I learned from those years in the prison camp, where all those constraints just were oppressive. You must never ever ever confuse, on the one hand, the need for absolute, unwavering faith that you can prevail despite those constraints with, on the other hand, the need for the discipline to begin by confronting the brutal facts, whatever they are. We’re not getting out of here by Christmas.

  • “All our planning was for flu”

    It’s interesting to see The Sunday Times turn its guns on the UK government and on Boris Johnson in particular. This piece by the Insight team, which hits print tomorrow, is utterly damning.

    Last week, a senior adviser to Downing Street broke ranks and blamed the weeks of complacency on a failure of leadership in cabinet. In particular, the prime minister was singled out.

    “There’s no way you’re at war if your PM isn’t there,” the adviser said. “And what you learn about Boris was he didn’t chair any meetings. He liked his country breaks. He didn’t work weekends. It was like working for an old-fashioned chief executive in a local authority 20 years ago. There was a real sense that he didn’t do urgent crisis planning. It was exactly like people feared he would be.”

    …An investigation has talked to scientists, academics, doctors, emergency planners, public officials and politicians about the root of the crisis and whether the government should have known sooner and acted more swiftly to kick-start the Whitehall machine and put the NHS onto a war footing.

    They told us that, contrary to the official line, Britain was in a poor state of readiness for a pandemic. Emergency stockpiles of PPE had severely dwindled and gone out of date after becoming a low priority in the years of austerity cuts. The training to prepare key workers for a pandemic had been put on hold for two years while contingency planning was diverted to deal with a possible no-deal Brexit.

    …the warnings appear to have fallen on deaf ears.

  • Being led by donkeys would be an improvement

    There’s a cartoon I love by Stephen Collins about Michael Gove. It riffs on the film Independence Day, and features the MP volunteering to fly a plane to defeat an alien invasion.

    When quizzed about his unsuitability – “you’ve never flown a fighter plane in your life!” – Gove is adamant that he’s the right man for the job.

    “I used to be a journalist,” the fictional Gove says. “for The Times. I wrote two articles about planes [and] I’ve got strong opinions about aliens.”

    The cartoon’s ending is one of my very favourite things.

    Unfortunately it’s not so funny when the threat isn’t fictional and the strong opinions are about ventilators for coronavirus patients.

    Earlier today, Financial Times public policy editor Peter Foster wrote about the “Ventilator Challenge”, where the UK government decided to specify a whole bunch of ventilators that aren’t suitable for coronavirus patients. His Twitter thread tells the story. It isn’t a happy one.

    The short version, as Foster puts it:

    What this speaks to is the deeply worrying tendency of this crop of politicians to think they know best.

    The ‘cut-the-crap’ ‘how-hard-can-it-be?’ attitudes that leads to headless decision making. It’s embarrassing.

    …Expert people TEARING their hair out at the willful numbskullery of the people at the top.

    If it weren’t for a combination of medical skill and sheer good luck, this fiasco would have killed people.

  • “A gamble that became an embarrassment”

    This is the kind of article that you read from behind your fingers. From the NYT: UK Paid $20 Million for New Coronavirus Tests. They Didn’t Work.

    The two Chinese companies were offering a risky proposition: two million home test kits said to detect antibodies for the coronavirus for at least $20 million, take it or leave it.

    The asking price was high, the technology was unproven and the money had to be paid upfront. And the buyer would be required to pick up the crate loads of test kits from a facility in China.

    Yet British officials took the deal, according to a senior civil servant involved, then confidently promised tests would be available at pharmacies in as little as two weeks. “As simple as a pregnancy test,” gushed Prime Minister Boris Johnson. “It has the potential to be a total game changer.”

    There was one problem, however. The tests did not work.

  • Make America Sick Again

    I fear that this extraordinary photo will become a tragedy in hindsight. It’s of protesters in Michigan, many of them armed, demanding the government lifts lockdown because “we’re tired of not being able to buy the things that we need, go to the hairdressers.” Some protesters’ cars blocked the entrances to a hospital, preventing ambulances from getting through.

    This potentially lethal idiocy is being inflamed by – of course – Fox News. Earlier this week, Fox’s Bill Bennet told Americans once again that the coronavirus isn’t a pandemic and that social distancing isn’t necessary. Protesters’ claims that the virus was less dangerous than the flu are just echoing what Fox has been telling them, and their president, for the last five weeks.

  • The next two years

    Ed Yong is one of our best science writers, and this piece for The Atlantic is a clear-eyed look on where we all go from here. Whenever the lockdown is lifted – and lifting it too soon will have lethal consequences – we will not just go back to business as usual.

    The pandemic is not a hurricane or a wildfire. It is not comparable to Pearl Harbor or 9/11. Such disasters are confined in time and space. The SARS-CoV-2 virus will linger through the year and across the world. “Everyone wants to know when this will end,” said Devi Sridhar, a public-health expert at the University of Edinburgh. “That’s not the right question. The right question is: How do we continue?”

  • Shifting the narrative

    The Conservatives are working on their exit strategy. Not how we’ll exit the lockdown; how they’ll shift the blame for their failures onto others, such as the NHS. For example:

    Care homes are not run by the NHS.

    Care homes used to be run by councils, but years of funding cuts have seen that provision almost disappear. Today, care homes are primarily for-profit private businesses.

    84% of English care home beds are owned and operated by private companies, 13% are run by voluntary organisations and 3% are run by councils. As the authors of a recent report into the sector put it:

    The state has abdicated its responsibility for providing care over recent decades. The private sector may have filled this gap but it consistently puts profits before people.

    …The fact that private equity-backed firms have taken over a significant share of the UK’s care provision, fuelled by debt and driven by the prospect of rising property prices and ever-lower care costs, puts our vital social care system at ever-increasing risk.

    One of my best friends is a care home worker. Like many in the sector they are on a zero hours contract and paid a pittance by a private and very profitable company; they have not been given PPE because the company doesn’t want to pay for PPE. Care homes can do, or in this case not do, whatever they want. Which is why so many people are dying in them.

    The government doesn’t want to be on the hook for those deaths, or for the growing death toll among front-line NHS staff. Hence the emerging narrative that it’s all the NHS’s fault. But it isn’t. The lack of PPE for front-line workers and other key equipment is the result of government decisions and indecision going back to January.

    The dread hand of news management has already kicked in: the allegation is now that key workers aren’t getting PPE because the lumbering, inefficient NHS isn’t allocating resources properly, not that the resources weren’t there in the first place. There are a lot of carefully worded claims doing the rounds, so for example the government is keen to talk about the overall number of items of PPE that have been distributed rather than the details of which items have gone where and in what quantities: there’s a big difference between a gown (which is inappropriate for aerosol-generating procedures) and an FFP2 surgical mask. If there were enough PPE, everyone in the country with a 3D printer wouldn’t be making making visors for NHS staff and nurses wouldn’t be making their own PPE from bin bags.

    Still, we can count on our fearless, non-partisan press ensuring they don’t get away with it. Can’t we?

    Image by Liz Gerard on Twitter. It shows the Sun’s reporting of the COVID-19 death toll last week.
  • Lethal stupidity on a truly horrific scale

    The Sun’s front page after nearly 1,000 people died in a single day.

    The official UK coronavirus death toll will crack 10,000 today. The real death toll, which unlike the official figures includes those who died in care homes, those who died at home and those who had not already been tested positive for COVID-19, is much higher.

    The Centre for Evidence Based Medicine has published a good explanation of why the official figures are inaccurate, complete with spreadsheets so you can see for yourself. The figures we’re given in the daily briefings do not tell us how many people died on a particular day. They tell us how many deaths in hospitals were reported that day. There is often a delay between the death occurring and the death being reported.

    Here’s an example. The figure for 8 April was 828 deaths, but none of the 828 deaths happened on the 8th of April. They happened on the 4th of March, and the 5th of March, and the 31st of March, and the 4th of April, up to the 7th of April. Some of the people who died on the 8th will be reported in the figures for the 9th, and the 10th, and so on.

    What that means is that there’s a big lag between people dying and their deaths being counted, and that lag can be dramatic: the officially announced death toll for 31 March was 679, but NHS England’s statistics now say it was 1,710. The difference isn’t usually that dramatic, but it does mean that the figures are at best a guide to what’s been happening rather than an accurate picture.

    [Update: that means you should prepare for very bad news in the early part of next week: there will be a lag due to the Easter holiday, so we’re likely to see a spike in numbers when those reports come in.]

    However you count it, we’re now on track to have the highest death toll of any country in Western Europe, despite having had more time to prepare than the rest of Western Europe.

    If you can bear to read it, there’s a timeline of the lethal arrogance that’s already killed thousands of people here.

    Nesrine Malik in The Guardian:

    It is a jarring experience to wake up to a British death toll that is almost a thousand a day, and not see that number on every front page, being put to every politician in every single interview, with a demand for an explanation. It is as if those who should be asking these questions, from the media to opposition politicians, have been subjected to a mass memory-erasing exercise. Every report showing the scale of the crisis should be framed in the language of accountability and anchored in the premise of preventability. With all the benefits of hindsight, the government dragged its feet, wasted precious time and infused the issue with a sense of British exceptionalism: drastic measures need not be taken because in the UK things will somehow be different.

    … It’s hard, as we lock down, to nurture an outrage that is based on decisions in the past when the loss of life is happening today – more so when the government has stealthily removed itself from the picture and shifted the responsibility entirely on to the public

    …Relocate the pain and recall that this need not have happened. Ten thousand people, in UK hospitals alone, have now died.

  • One in ten

    At the time of writing:

    101,000 – total global deaths from Covid-19

    8,958 – total UK deaths from the same virus, excluding hundreds more in care homes

    The UK has nearly one in ten of the global deaths from this virus despite being one of the most recent countries to get it.

    Today’s daily death toll, 980, means for two days running the UK has had more daily deaths than the worst days in Italy or France.

    That’s despite having the benefit of time to see how the virus has spread in other countries, time to order protective equipment and ventilators, time to plan an effective response. Time other countries didn’t have.

    Things could have been even worse. If the football authorities hadn’t become fed up with government inaction and decided to cancel multiple big games in March, the numbers  would be even higher.

    This is a political failure on a truly horrific scale.

    It’s time for the press to do its job and hold the government to account.